完全腹腔镜下肝部分切除25例临床探讨

Clinical approach of total laparoscopic partial hepatectomy in 25 cases

目的总结完全腹腔肝切除的经验。方法2004年12月至今我院共完成25例完全腹腔镜肝切除手术,手术方式包括规则性左肝外叶切除17例,右肝Ⅵ段切除3例,局部切除5例。结果25例均在完全腹腔镜下行肝切除手术,无中转开腹,手术时间60-150分钟,术中出血量50-300ml,术后住院3～9天,术中术后未发现大出血,1例出现少量胆漏,引流7天后愈合。病理报告肝癌15例,良性病变12例。肝癌术后随访2-31个月,未见肝内复发及切口肿瘤种植,所有患者均健康存活。结论在一定条件下完全腹腔镜肝切除治疗肝脏某些疾病是安全、有效、可行的方法。

Objective To summarize the experience of total laparoscopic partial hepatectomy （TLH） . Methods From December 2004 up till the precent, 25 cases were underwent TLH in our department. Surgical procedures in cluded 17 cases left lateral liver, 3 cases of Ⅵ segment of liver. 5 cases of local resections.Results laparoscopic hepatectomy was uneventfully accomplished in all the 25 patients. Without conversions to open surgery. The operation time was 60-150 min. and the intraoperative blood loss way 50-300 ml. The postoperative hosptal stay was 3-9 days With no major complications. Biliary fistula occurred in 1 case which were cured by drainage for 7 days. The pathological result included 15 malignant and 12 benign diseases. Follow-up check ups for 2-31 months, revealed no turnout recurrence or incision implantantion. All the patients survived.Conclusions Total laparoscopic hepatectomy can be carried out an effectively for some diseases if it is used properly.